Provider Demographics
NPI:1376543090
Name:SOURYAL, TAREK O
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:O
Last Name:SOURYAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 SNIDER PLZ
Mailing Address - Street 2:#200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5648
Mailing Address - Country:US
Mailing Address - Phone:214-369-7733
Mailing Address - Fax:214-369-7739
Practice Address - Street 1:6901 SNIDER PLZ
Practice Address - Street 2:#200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5648
Practice Address - Country:US
Practice Address - Phone:214-369-7733
Practice Address - Fax:214-369-7739
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3079207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C22087Medicare UPIN